A new classification system for gingival and palatal recessionAshish Kumar, Sujata Surendra MasamattiMarch-April 2013, 17(2):175-181DOI:10.4103/0972-124X.113065 PMID:23869122

Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. To propose a new classification system that gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to present classifications. A separate classification system for palatal recessions (PR) is also proposed. This article outlines the limitations of present classification systems and also the inability to classify PR. A new comprehensive classification system is proposed to classify recession on the basis of the position of interdental papilla and buccal/lingual/palatal recessions.

Treatment of gingival recession has become an important therapeutic issue due to increasing cosmetic demand. Multiple surgical procedures have been developed to obtain predictable esthetic root coverage. More specifically, after periodontal regenerative surgery, the aim is to achieve complete wound healing and regeneration of the periodontal unit. A recent innovation in dentistry is the preparation and use of platelet-rich plasma (PRP), a concentrated suspension of the growth factors, found in platelets. These growth factors are involved in wound healing and postulated as promoters of tissue regeneration. This paper reports the use of PRF membrane for root coverage on the labial surfaces of the mandibular anterior teeth. This was accomplished using laterally displaced flap technique with platelet rich fibrin (PRF) membrane at the recipient site.

The human characteristics of curiosity, wonder, and ingenuity are as old as mankind. People around the world have been harnessing their curiosity into inquiry and the process of scientific methodology. Recent years have witnessed an unprecedented growth in research in the area of nanoscience. There is increasing optimism that nanotechnology applied to medicine and dentistry will bring significant advances in the diagnosis, treatment, and prevention of disease. Growing interest in the future medical applications of nanotechnology is leading to the emergence of a new field called nanomedicine. Nanomedicine needs to overcome the challenges for its application, to improve the understanding of pathophysiologic basis of disease, bring more sophisticated diagnostic opportunities, and yield more effective therapies and preventive properties. When doctors gain access to medical robots, they will be able to quickly cure most known diseases that hobble and kill people today, to rapidly repair most physical injuries our bodies can suffer, and to vastly extend the human health span. Molecular technology is destined to become the core technology underlying all of 21 st century medicine and dentistry. In this article, we have made an attempt to have an early glimpse on future impact of nanotechnology in medicine and dentistry.

Rehabilitation of complicated cases poses difficulty in clinical practice, both with respect to restoring function and with esthetics. One such clinical condition where the dentist has to give importance to proper planning of the treatment and execution of the plan is amelogenesis imperfecta (AI), a condition where both function and esthetics are accommodated. This article discusses both the functional and esthetic rehabilitation of a patient with AI. Both the esthetics and function were hampered in this patient due to the condition. As a result, the treatment was properly planned and executed. A number of treatment options are available for us today to treat such a case. There is no one technique to be followed as such. However, the aim was to properly diagnose the case and provide good function and esthetics to the patient.

In the field of periodontology and implantology, assessment of the condition of teeth and surrounding alveolar bone depends largely on two-dimensional imaging modalities such as conventional and digital radiography. Though these modalities are very useful and have less radiation exposure, they still cannot determine a three-dimensional (3D) architecture of osseous defects. Hence, an imaging modality which would give an undistorted 3D vision of a tooth and surrounding structures is essential to improve the diagnostic potential. Cone-beam computed tomography (CBCT) provides 3D images that facilitate the transition of dental imaging from initial diagnosis to image guidance throughout the treatment phase. This technology offers increased precision, lower doses, and lower costs when compared with medical fan-beam CT. This review discusses all the finer details of CBCT which not only reveals 3D architecture of the periodontium but also helps to reconstruct it.

The main aim of this review is to update the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Exclusive data is available on the association between these two chronic diseases till date. Articles published on this relationship often provide the knowledge of definitions of diabetes mellitus and periodontal diseases, prevalence, extent, severity of periodontal disease, complications of diabetes along with the possible underlying mechanisms. The authors reviewed human epidemiological studies, cross-sectional observations and longitudinal cohort, case control that evaluated variables exclusively over the past 30 years and the predominant findings from the "certain" articles are summarized in this review. This review clarifies certain queries such as 1) Do periodontal diseases have an effect on the metabolic control of diabetes? 2) Does diabetes act as a risk factor of periodontitis? 3) What are the possible underlying mechanisms relating the connection between these two chronic diseases? 4) What is the effect of periodontal intervention on metabolic control of diabetes? After a thorough survey of literature, it was observed that diabetes acts as a risk factor in development of periodontitis as periodontitis is significantly aggravated in patients suffering from diabetes having long term hyperglycemia. Different mechanisms underlying the association between the accelerated periodontal disease and diabetes are emerging but still more work is required. Major efforts are required to elucidate the impact of periodontal diseases on diabetes. At the same time, patients are needed to be made aware of regular periodontal maintenance schedule and oral hygiene.

An aberrant frenum is postulated to create functional and aesthetic problems. Archer's 'classical frenectomy' is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edward's frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented.

Background: Periodontitis is one of the major reasons for tooth loss in adults. India, with a population of over 1 billion, is bound to become a developed nation soon. This transition will require a population that is healthy, including in terms of periodontal health. Early studies done in India gave an indication that the population is highly susceptible to periodontitis. Aim: This paper reviews the prevalence of periodontitis in the Indian population. Settings and Design: Review of periodontitis prevalence studies on the Indian population. Materials and Methods: After identifying articles from PubMed and hand searching, the epidemiology of periodontitis is reviewed together with the case definition, study settings, type of population, age and other factors as all these are bound to affect the prevalence rates determined in various studies. Statistical Analysis: None. Results: This review identifies very limited number of studies that provide prevalence data and faces difficulty in comparing various studies due to nonstandardization of case definition and use of nonrepresentative samples. There is a high prevalence of periodontitis among the adults and the economically weak population. Conclusions: There is a very urgent need for standardized population-based studies with a robust design to identify the true prevalence of periodontitis, which in turn will help in planning oral health policies and creating the necessary infrastructure.

Drug-induced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction (ADR) in patients treated with anticonvulsants, immunosuppressants, and calcium channel blockers. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. It gradually becomes a source of pain and the condition often leads to disfiguration. Within the group of patients that develop this unwanted effect, there appears to be variability in the extent and severity of the gingival changes. It would seem pertinent to identify and explore possible risk factors and relating them with the treatment plan. This article throws light on respective drugs and their association with gingival overgrowth and approaches to treatment based on current knowledge and investigative observations.

Frenal attachments are thin folds of mucous membrane with enclosed muscle fibers that attach the lips to the alveolar mucosa and underlying periosteum. Most often, during the oral examination of the patient the dentist gives very little importance to the frenum, for assessing its morpholology and attachment. However, it has been seen that an abnormal frenum can be an indicator of a syndrome. This paper highlights the different frenal attachments seen in association with various syndromic as well as non-syndromic conditions.

Talking about periodontic-orthodontic interrelationships is related primarily to the 1960s, where a generalized increase in salivary bacterial counts, especially Lactobacillus, had been shown after orthodontic band placement. The purpose of this article is to provide the dental practitioner with basic understanding of the interrelationship between periodontics and orthodontics by means of representing classical studies, and, to give an update on this topic by demonstrating the most recent opinions concerning periodontic-orthodontic interrelationships. Specific areas reviewed are the ability of orthodontic treatment to afford some degree of protection against periodontal breakdown, short-term and long-term effects of orthodontic treatment on the periodontium, and some mucogingival considerations. Topics considering orthodontic treatment in periodontally compromised patients were not included in this review. While past studies have shown that orthodontic treatment can positively affect the periodontal health, recent reviews indicate an absence of reliable evidence for the positive effects of orthodontic therapy on patients' periodontal status. Periodontic-orthodontic interrelationships are still controversial issues. However, a standard language between the periodontist and the orthodontist must always be established to eliminate the existing communications barrier, and to improve the outcomes of the whole treatment.

Excessive gingival display, commonly referred to as 'gummy smile' is a major hurdle in overall personality of an individual. Gummy smile, secondary to altered passive eruption and tooth mal-positioning, can be predictably treated with Surgery and orthodontic therapy. In patients with jaw deformities, orthognathic surgery can be performed. However, this requires hospitalization and entails significant discomfort. Lip repositioning is a simple surgical procedure to treat 'gummy smile'. The procedure restricts the muscle pull of the elevator lip muscles thereby reducing the gingival display while smiling. This procedure is safe and predictable with minimal risk or side effects. This case report describes the successful treatment of excessive gingival display using surgical lip repositioning procedure which can be used as an alternative treatment modality for treatment of excessive gingival display.

Macfarlane Burnett stated in 1962 that "By the late twentieth century, we can anticipate the virtual elimination of infectious diseases as a significant factor in social life". Probiotics have become of interest to researchers in recent times. Time has come to shift the paradigm of treatment from specific bacteria elimination to altering bacterial ecology by probiotics. The development of resistance to a range of antibiotics by some important pathogens has raised the possibility of a return to the pre-antibiotic dark ages. Here, probiotics provide an effective alternative way, which is economical and natural to combat periodontal disease. Thus, a mere change in diet by including probiotic foods may halt, retard, or even significantly delay the pathogenesis of periodontal diseases, promoting a healthy lifestyle to fight periodontal infections.

Background: In dentistry, esthetics has a special place. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics. Materials and Methods: A method of de-epithelialization of the pigmented gingiva using Kirkland's gingivectomy knife is described. Twenty patients who were conscious about their gingival melanin pigmentation were selected. The gingiva of the whole of the arch was abraded until the entire visible pigmentation was removed. Clinical observations for intensity of pigmentation were recorded at baseline and then after surgery at monthly intervals over a period of 9 months according to Dummett-Gupta Oral Pigmentation Index scoring criteria proposed by Dummett C. O. in 1964. Results: The mean gingival melanin pigmentation score came down to 0.407 after 9 months as compared to preoperative score, which was 2.24. No repigmentation occurred in fair-complexioned persons. In persons with wheatish complexion, repigmentation was seen in 85.71% of the cases, but scores came down to 0.38 postoperatively as compared to 2.27 preoperatively. In dark complexioned persons, repigmentation occurred in all cases, but the mean scores were 0.93 as compared to 2.40 preoperatively. The difference between preoperative and postoperative mean scores for each segment was put to statistical analysis by applying paired t test and was found to be significant. Conclusion: As this method has shown statistically significant results, it can be used in patients who are conscious of pigmented gingiva and want an esthetically satisfactory color.

Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.

Background: We face various problems while measuring the Clinical attachment level (CAL) from Cemento-enamel junction (CEJ). This study aims to record and compare the CEJ location measurements using a xed reference point (FRP) [Custom made stent] before and after ap elevation. Materials and Methods: A custom made stent and UNC-15 probe were used. Recording of CEJ location was made using a UNC-15 (Hu-Friedy) probe, before (close CEJ) and after (Open CEJ) the reflection of the flap from the lower edge of the stent in those subjects who were indicated for flap surgery, at baseline. Results: We used statistical analysis involving intra-group comparison done by Paired-'t' test. The close and the open CEJ measurements demonstrated a, statistically, non-significant difference. The equi-measurements of close and open CEJ numerical data were remarkably lower than the under and overestimation of measurements. Thus, despite certain disadvantages of stent, the FRP provides a simple solution for CAL measurement. Conclusion: The results of this study confirms the objective of the study and strongly suggests that CAL measurements done without FRP is subjected to great variation and the diagnostic and prognostic interpretation of CAL should be viewed seriously in periodontics.

Periodontal destruction is initiated by bacteria that stimulate host responses leading to excess production of cytokines. Anticytokine therapy for periodontal diseases especially targets proinflammatory cytokines, that is, TNF-α, IL-1, and IL-6, because these are essential for the initiation of the inflammatory immune reaction and are produced for prolonged periods in periodontitis. This therapy aims to bind the cytokines with the receptors present on target cells such as the fibroblasts. The three basic treatment strategies are: (1) neutralization of cytokines, (2) blockage of cytokine receptors, and (3) activation of anti-inflammatory pathways, such as, immune-suppressive pathways.
This new therapy can act as a host response modulator in the control of inflammatory diseases of gums and may provide the basis for new molecular therapeutic approaches to the treatment of periodontitis.

With increased awareness about dental esthetics, multidisciplinary periodontal therapy has begun to gain momentum. Management of severely attrited teeth is a challenging situation and is dealt with a multidisciplinary approach. In cases of severe tooth wear, the crown height is drastically reduced, in some cases up to the gingival level. This might require a contribution from the disciplines of endodontics, periodontics, orthodontics and prosthodontics for predictable results. Herein we describe the management of one such case.

Osteoimmunology is an emerging field of research dedicated to the relationship between the immune processes and the bone metabolism of various inflammatory bone diseases. The regulatory mechanisms governing the osteoclast and osteoblast are critical for understanding the health and disease of the skeletal system. These interactions are either by cell to cell contact or by the secretion of immune regulatory mediators like cytokines and chemokines by immune cells that are governed by the RANKL (TRANCE)-RANK- OPG axis. TRANCE-RANK signaling has served as a cornerstone of osteoimmunology research. There is increased recognition of the importance of the inflammatory and immune responses in the pathogenesis of periodontal disease. Thus, this field has provided a framework for studying the mechanisms underlying periodontal destruction. As bone homeostasis is mainly regulated by both the immune and endocrine systems, there emerged osteoimmunoendocrinology where adipokines take the lead. This review focuses on the underlying concepts of osteoimmunology, its relation to Periodontics.

Early detection of disease plays a crucial role in successful therapy. Early diagnosis and management reduces the severity and possible complications of the disease process. To overcome this challenge, medical researchers are devoted to finding molecular disease biomarkers that reveal a hidden lethal threat before the disease becomes complicated. Saliva, an important physiologic fluid, containing a highly complex mixture of substances, is rapidly gaining popularity as a diagnostic tool. Periodontal disease is a chronic disease of the oral cavity comprising a group of inflammatory conditions affecting the supporting structures of the dentition. In the field of periodontology, traditional clinical criteria are often insufficient for determining sites of active disease, for monitoring the response to therapy, or for measuring the degree of susceptibility to future disease progression. Saliva, as a mirror of oral and systemic health, is a valuable source for clinically relevant information because it contains biomarkers specific for the unique physiologic aspects of periodontal diseases. This review highlights the various potentials of saliva as a diagnostic biomarker for periodontal diseases.

An adequate amount of keratinized gingival tissue that is under proper plaque control, is a fundamental requirement for periodontal health. When the teeth erupt uneventfully in the center of the alveolar ridge, an adequate amount of keratinized tissue will surround the erupted permanent tooth. Labially or buccally erupting teeth show reduced dimensions of the gingiva as abnormal eruption of permanent teeth restricts or eliminates the keratinized tissue between the erupting cusp and the deciduous tooth. A lack of attached gingiva poses a potential risk for gingival recession in labially or buccally erupted teeth due to the possibility of accumulation of plaque and/or traumatic tooth-brushing during subsequent orthodontic treatment. A good understanding between the orthodontist and periodontist along with proper management of periodontal tissues, can prevent these problems. Various surgical techniques can be employed to uncover impacted teeth. This paper discusses the validity of utilizing periodontal surgery to increase a band of keratinized tissue in a case of an impacted canine erupting from the alveolar mucosa.

Background: Attempts to successfully regenerate lost alveolar bone have always been a clinician's dream. Angular defects, at least, have a fairer chance, but the same cannot be said about horizontal bone loss. The purpose of the present study was to evaluate the prevalence of horizontal alveolar bone loss and vertical bone defects in periodontal patients; and later, to correlate it with the treatment modalities available in the literature for horizontal and vertical bone defects. Materials and Methods: The study was conducted in two parts. Part I was the radiographic evaluation of 150 orthopantomographs (OPGs) (of patients diagnosed with chronic periodontitis and seeking periodontal care), which were digitized and read using the AutoCAD 2006 software. All the periodontitis-affected teeth were categorized as teeth with vertical defects (if the defect angle was ≤45° and defect depth was ≥3 mm) or as having horizontal bone loss. Part II of the study comprised search of the literature on treatment modalities for horizontal and vertical bone loss in four selected periodontal journals. Results: Out of the 150 OPGs studied, 54 (36%) OPGs showed one or more vertical defects. Totally, 3,371 teeth were studied, out of which horizontal bone loss was found in 3,107 (92.2%) teeth, and vertical defects were found only in 264 (7.8%) of the teeth, which was statistically significant (P<.001). Search of the selected journals revealed 477 papers have addressed the treatment modalities for vertical and horizontal types of bone loss specifically. Out of the 477 papers, 461 (96.3%) have addressed vertical bone loss, and 18 (3.7%) have addressed treatment options for horizontal bone loss. Two papers have addressed both types of bone loss and are included in both categories. Conclusion: Horizontal bone loss is more prevalent than vertical bone loss but has been sidelined by researchers as very few papers have been published on the subject of regenerative treatment modalities for this type of bone loss. This study should be an impetus for greater attention to an otherwise ubiquitous periodontal challenge.

Aims and Objectives : Anemia of chronic disease (ACD) is one of the most common forms of anemia. It is defined as anemia occurring in chronic infections, inflammatory conditions or neoplastic disorders which are not due to marrow deficiencies or other diseases, and occurring despite the presence of adequate iron stores and vitamins. Periodontitis is one of the most prevalent chronic inflammatory diseases in humans. This study aimed at finding out if periodontitis, like other inflammatory conditions, could lead to anemia. Materials and Methods : Thirty chronic generalized periodontitis male patients with hemoglobin levels below 15 mg/dl and serum ferritin values above 30 ng/ml were selected. The various blood parameters recorded at baseline were hemoglobin levels(Hb), erythrocyte count (RBC), erythrocyte sedimentation rate (ESR), mean corpuscular volume(MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). Periodontal parameters recorded at baseline included: plaque index, gingival index, probing pocket depth, clinical attachment level. Periodontal treatment including surgery if required was carried out in all the patients. Periodontal status of patients was monitored by repeating evaluation of periodontal indices at three months and at the end of one year. The hematological values were again measured at the end of one year. Results: The results showed that correction of periodontal inflammation resulted in a significant increase in hemoglobin levels and erythrocyte counts. The erythrocyte sedimentation rate showed a reduction indicating resolution of periodontal inflammation. There was a significant, but much lesser, improvement in MCV, MCH and MCHC values. Conclusion: The results of this study showed that treatment of periodontitis leads to an improvement in hematocrit and other related blood parameters in chronic generalized periodontitis patients with anemia. This provides evidence that periodontitis like other chronic diseases may also cause anemia.